Cardiac sarcoidosis

Case contributed by Dr Tim Luijkx

Presentation

No symptoms. Employment-related medical check-up revealed abnormal ECG and dilated left ventricle.

Patient Data

Age: 25
Gender: Male
Modality: MRI

Patient characteristics:
Dimensions: LV 62 mm, RV 39 mm, septum 11 mm

LV function: EF 35%, SV 92 ml, EDV 265 ml (125 ml/m²), ESV 173 ml (82 ml/m²)
RV function: EF 47%, SV 97 ml, EDV 208 ml (98 ml/m²), ESV 111 ml (52 ml/m²)

Mitral valve: normal bifasic flow and E/A ratio, stroke volume 86 ml, peak velocity 0.6 m/sec.
Aortic valve: tricuspid valve, stroke volume 94 ml, peak velocity 1.2 m/sec.

Global hypokinesia of left ventricle, most prominent in several focal areas of thinned ventricular wall and late enhancement. There is extensive late enhancement in a non-ischaemic pattern:

  • mid-wall of the interventricular septum
  • epicardial in the anterior, anterolateral and inferior LV wall
  • superior portion of (lateral) papillary muscles.
  • inferior RV wall 
  • RV outflow tract

There is also slight RV hypokinesia without focal akinesia or dyskinesia. No lymphadenopathy or other gross abnormalities visible on survery images.

Conclusion:
Dilated LV with poor function (ejection fraction 35%). Extensive late enhancement in a non-ischaemic pattern, most pronounced in LV, but also in RV. Images most consistent with sarcoidosis. Differential diagnosis includes (status after) extensive myocarditis or other cardiomyopathy.

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Case Information

rID: 39811
Case created: 21st Sep 2015
Last edited: 28th Sep 2015
System: Cardiac
Inclusion in quiz mode: Included

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